Königshütte, 1917
Ludwig Guttmann was born on the 3rd of July 1899 in Tost, Germany. At the age of 3, his family moved from the little village of Tost to Königshütte, a town with a large foundry in a coal-mining district. A strapping young coalminer with a fracture of the spine was his first encounter with paraplegia. That was in 1917, when he used to work as a volunteer in an accident hospital for coalminers. When he began to write up his notes, he was told: “Don’t bother, he’ll be dead in a few weeks.” So it was.
After five weeks, urinary infection and massive pressure sores led to fatal sepsis. Guttmann remembered that patient for the rest of his life.
While studying medicine at Freiburg from 1919 until 1924, he became active in a Jewish fraternity, whose purpose was information and awareness against anti-Semitism in the universities. This fraternity gradually evolved into a centre of physical training and sport, to acquire body strength, skills, confidence and self-esteem so that “nobody needed to be ashamed of being a Jew”. When Guttmann graduated medical school in 1924, financial reasons forced him to return to Breslau.
There was a position in the neurological department of distinguished professor Otfrid Foerster, which Guttmann was happy to accept. From 1928 he worked as a neurosurgeon in a 300 bed psychiatric clinic at Hamburg University and in 1929 he returned to Breslau to become Foerster’s assistant.
Persecution in Breslau
In 1933 it was prohibited for Jews to practice medicine in public hospitals. Guttmann was fired on 30th June 1933 but immediately took over as the director of the neurological and neurosurgical department of the Breslau Jewish hospital. After Hitler’s rise to power, the position of Germans with Jewish origin was getting more and more difficult. He had plenty of proposals to migrate abroad so he could carry on with his career. He did not accept any because he believed that Nazism would not last for long.
He became president of the Jewish Medical Association and many times he exposed himself to danger by helping refugees and patients. In September 1938 he was ordered by the Gestapo to discharge all non-Jewish patients from the Jewish Hospital that he was managing. Later that same year, when thousands of Jews were taken to concentration camps, Guttmann was summoned by the local Gestapo Commissar to justify the presence of 63 patients that were admitted to his hospital following the November Pogroms.
He managed to save all but three that were sent to concentration camps. It was then that he realised that he would have to leave Germany.
Refuge in Britain
He arrived in Britain on the 14th March 1939, after he was invited by the “Society for the Protection of Science and Learning”, with his wife, two children and no money. With the sponsorship of Hugh Cairns, one of the leading neurosurgeons of that period, he started his research in Oxford.
The mortality rate of traumatic paraplegia in British and American armies during World War II was still very high, reaching almost 80%. The few survivors carried on living as useless and hopeless cripples, unemployable and unwanted, condemned for the rest of their lives to institutions for incurable patients with no encouragement to return to a normal life. Life expectancy was a mere 3 months following injury.
In December 1941, Guttmann presented a review, required by the Medical Research Council of England, with regards to the way that patients suffering from spinal cord injuries were dealt with and rehabilitated. As a result of that presentation the Medical Research Council decided on the creation of a special centre for patients with spinal cord injuries.
That decision was also a part of the greater preparation for the planned attack of the second front during the spring of 1944, as the number of such patients was anticipated to rise.
Stoke Mandeville
In September 1943 the British government commissioned Guttmann as director of that centre at Stoke Mandeville hospital in Aylesbury. Guttmann accepted under the condition that he would be totally independent and that he could apply his philosophy as far as the whole approach to the treatment of those patients was concerned.
Guttmann’s goal was the integration of these patients into society as respectable and useful members despite their high degree of disability. The ever repeated question “Is it really worth while?” asked by all visitors during the first two years that the centre operated was indicative as to how difficult it was to get over century old perceptions and prejudices.
One of the most difficult tasks for a paraplegic is to cheer up his visitors!
The centre opened on 1st February 1944 with 26 beds, and so a new era for spinal injuries patients began. Guttmann introduced a whole new approach to the way tetraplegic and paraplegic patients were treated from the initial stages of injury until final resettlement.
Although Guttmann did not think of himself as a psychologist, the whole structure of the rehabilitation programme shows deep understanding of the psychology of the patient with spinal cord injury.
Sport as therapy
Physical training and sports played an essential role during the Jewish revival after the end of the 19th century. It was not just an expression of a new Jewish self-confidence but also a way for the integration of Jews into a non-Jewish environment. One can assume that Guttmann’s involvement in sports activities during his youth in Germany, as a member of the Jewish fraternity, played an important part in the inclusion of sports in the rehabilitation programme for the spinal injuries patients.
Guttmann’s programme aimed at reintegration into a normal life, which especially in a society such as Great Britain included sport.
Besides sport’s therapeutic value as complement to traditional physiotherapy (in restoring the disabled person’s strength, co-ordination, speed and endurance), sports events have a great advantage because of their recreational and psychological value.
At the same time, sport (according to Guttmann) counteracts abnormal psychological and antisocial attitudes – which helps to prevent a disabled person’s attitude from deteriorating into an inferiority complex characterised by anxiety and loss of self-confidence and personal dignity, resulting in self-pity and self-isolation.
The aims of sport are to develop self-discipline, self-respect, competitive spirit and comradeship, mental attitudes that are essential for the disabled person’s integration into the community.
The birth of the Paralympic Games
The team games that Guttmann incorporated in the rehabilitation programme soon developed into sports activities in which men, women and children could participate upon their discharge from the National Spinal Injuries Centre. Soon more patients from other units all over Great Britain started participating. A sports movement was developed that became known as the Stoke Mandeville Games.
The first Games, with 14 ex-servicemen and 2 ex-servicewomen competing in archery on the grass outside the hospital ward, were held on 28th July 1948, the same day that the London Olympic Games started. The date was not chosen by accident, Guttmann wanted his games to have a larger forum. He envisioned international games. Since 1948, the Stoke Mandeville Games were held every year.
In 1952 a team of Dutch paraplegic war veterans crossed the channel to compete with their comrades at Stoke Mandeville in the first international games for athletes with disabilities.
The term “Paralympic Games” was adopted later in 1984 by the International Olympic Committee.
It was decided that the games should be held in the country hosting the Olympic Games. This happened for the first time in 1960 in Rome, right after the Olympic Games. About 350 athletes with disabilities, men and women from 23 countries, participated. At the 1964 Games in Tokyo, Mexican observers were present with the purpose of staging the Games together with the Olympic Games in Mexico City.
There was some surprise when two years prior to the 1968 event, the Mexican government backed out of the commitment to host the Paralympics because of technical difficulties.
Wanting to keep the tradition going, Sir Ludwig Guttmann accepted the invitation of the Israeli government to host the 1968 International Stoke Mandeville Games at Ramat Gan near Tel Aviv. Israel’s offer to host the Games was motivated by its wish to mark its 20th anniversary of independence. The opening ceremony on 4 November was held at the Hebrew University stadium in Jerusalem, before a crowd of more than 10,000 people. The Games were declared open by the deputy prime minister, Yigal Allon.
A total of 750 athletes from 29 countries participated.
The Paralympic Games have become a world wide phenomenon, watched and followed by millions. This has achieved a tremendous admiration and understanding of disabled people, especially in countries who previously denied and hid disability.
2012 saw the Paralympics in London return to their country of birth with the Guttmann Stadium at Stoke Mandeville playing an important part in welcoming many teams, especially as a training centre.
A worldwide legacy
Guttmann directed the National Spinal Injuries Centre for 22 years. When he retired from his clinical work in 1966, the centre had increased to 200 beds.
The question today is: Would a Stoke Mandeville centre have been created without the events in Germany and their consequences? Would rehabilitation of spinal cord injured people have been his lifetime’s work without emigrating? Would the world’s negative prejudices about the “incurable” paralysis have changed without the refugee Guttmann? Guttmann himself answered these questions by referring to Winston Churchill:
Since the Nazis drove out Jewish scientists, British science has got ahead of the Germans.
Today Guttmann is internationally recognised as a pioneer in the field of rehabilitation for spinal injury patients. Since 1948 he was counsel to many governments in the world in matters of paraplegic rehabilitation and he promoted the creation of many paraplegic centres. The Stoke Mandeville centre became an example for 40 other rehabilitation centres around the world. In 1966, the first paraplegic centre at a German University in Heidelberg was set up bearing his name, “Ludwig Guttmann House”.
In Barcelona, the spinal centre is known as the Guttmann Centre.
Of the many forms of disability which can beset mankind, a severe injury or disease of the spinal cord undoubtedly constitutes one of the most devastating calamities of human life.
Due to his vital and groundbreaking work, the lives of spinal injured people around the world have been improved to an extent that nobody thought possible.